Diabetic Retinopathy

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Diabetic Retinopathy
Michigan Medical, P.C. Ophthalmology Dr. Marko
Habekovic

• Information and Treatment

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The healthy eye

• Light rays enter the eye through the cornea,
  pupil and lens.
• These light rays are focused directly onto the
  retina, the light-sensitive tissue lining the
  back of the eye.
• The retina converts light rays into impulses
  sent through the optic nerve to your brain, where
  they are recognized as images.

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What is diabetes?

• Diabetes Mellitus is the inability of the body to
  use and store sugar properly, resulting in high
  blood sugar levels.
• Results in changes in veins, arteries and
  capillaries in the body.

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How does diabetes affect vision?

• Could develop cataracts (clouding of the
  naturally clear lens in the eye).
• May develop glaucoma (a disease of the optic
  nerve).
• Risk of developing diabetic retinopathy damage
  occurs to the fragile blood vessels inside the
  retina.

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Diabetic retinopathy

• Two types of diabetic retinopathy
• Nonproliferative diabetic retinopathy (NPDR)
• Early stage diabetic retinopathy
• Proliferative diabetic retinopathy (PDR)
• Later stage diabetic retinopathy

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Nonproliferative diabetic retinopathy (NPDR)

• Also called background diabetic retinopathy.
• Earliest stage of diabetic retinopathy.
• Damaged blood vessels in the retina leak extra
  fluid and small amounts of blood into the eye.
• Cholesterol or other fat deposits from blood,
  called hard exudates, may leak into retina.

Top Healthy retina Bottom Retina with NPDR,
containing hard exudates
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Nonproliferative diabetic retinopathy

• With NPDR, your central vision is affected by any
  of the following
• Hard exudates on the central retina (macula).
• Microaneurysms (small bulges in blood vessels of
  the retina that often leak fluid).
• Retinal hemorrhages (tiny spots of blood that
  leak into the retina).
• Macular edema (swelling/thickening of macula).
• Macular ischemia (closing of small blood
  vessels/capillaries).

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Nonproliferative diabetic retinopathy

• Macular edema
• Macula thickens or swells, affecting vision.
• Most common cause of vision loss in diabetes.
• Vision loss may be mild to severe.
• Peripheral (side) vision remains.
• Laser treatment may help to stabilize vision.

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Nonproliferative diabetic retinopathy

• Macular ischemia
• Small blood vessels, or capillaries, close,
  blurring vision.
• Macula no longer receives enough blood to work
  properly.
• Currently no effective treatment for macular
  ischemia.

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Proliferative diabetic retinopathy (PDR)

• Later stages of diabetic retinopathy.
• Abnormal blood vessels begin to grow on surface
  of retina or optic nerve cant provide retina
  with normal blood flow (neovascularization).
• PDR can cause severe visual loss and other
  serious complications, such as neovascular
  glaucoma and loss of the eye.

Top Healthy retina Bottom Retina with PDR and
neovascularization
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Proliferative diabetic retinopathy

• With PDR, vision is affected when any of
• the following occur
• Vitreous hemorrhage (new, abnormal blood vessels
  bleed into vitreous gel in center of eye,
  preventing light rays from reaching the retina).
• Traction retinal detachment (new, abnormal blood
  vessels begin to shrink and tug on retina may
  cause retina to detach).
• Neovascular glaucoma (neovascularization occurs
  in the iris, causing pressure to build up in the
  eye, damaging the optic nerve).

Vitreous hemorrhage
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Diagnosing diabetic retinopathy

• Diabetes can cause vision in both eyes to change,
  even if you do not have retinopathy.
• Rapid changes in your blood sugar alter the shape
  of your eyes lens, and the image on the retina
  will become out of focus.
• You can reduce episodes of blurred vision by
  maintaining good control of your blood sugar.

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Diagnosing diabetic retinopathy

• People with diabetes should see their
  ophthalmologist immediately if they have visual
  changes that
• Affect only one eye
• Last more than a few days
• Are not associated with a change in blood sugar
• It is important that your blood sugar be
  consistently controlled for several days prior to
  seeing your ophthalmologist for an exam.
• Uneven blood sugar causes a change in your eyes
  focusing power, interfering with your
  ophthalmologists measurements.

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When to schedule an eye exam

• If you were 30 years old or younger when your
  diabetes was first detected, you should have your
  first eye exam within five years after that
  diagnosis.
• If you were 30 years old or older, your first
  exam should be within a few months of the
  diabetes diagnosis.
• If you are pregnant, you should have an exam
  within the first trimester.
• If you already have experienced a high-risk
  condition, such as kidney failure or amputation
  related to diabetes, schedule an eye exam
  immediately.

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What happens during an eye exam

• Your ophthalmologist will dilate your pupils and
  examine your retina with special instruments
  using bright lights.
• Fluorescein angiography a diagnostic procedure
  using a special camera to take photographs of the
  retina after a small amount of yellow dye
  (fluorescein) is injected into a vein in your
  arm.
• The photographs of fluorescein dye traveling
  throughout the retinal vessels show
• Which blood vessels are leaking fluid
• How much fluid is leaking
• How many blood vessels are closed
• Whether neovascularization is beginning

Fluorescein angiogram
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What happens during an eye exam

• Fluorescein angiography helps the doctor
  determine
• Why vision is blurred.
• Whether laser treatment should be started.
• Where to apply laser treatment.

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What happens during an eye exam

• Ultrasound
• If your ophthalmologist cannot see the retina
  because of vitreous hemorrhage, an ultrasound
  test may be done in the office.
• The ultrasound sees through the blood to
  determine if your retina has detached.
• If there is detachment near the macula, prompt
  surgery may be necessary.
• After evaluation, your ophthalmologist will
  decide when you need to be treated or re-examined.

Retinal detachment
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Treating diabetic retinopathy

• Best treatment is to prevent development of
  retinopathy as much as possible.
• Strict control of your blood sugar will
  significantly reduce the long-term risk of vision
  loss from diabetic retinopathy.
• Laser surgery is often recommended for people
  with macular edema, PDR, and neovascular glaucoma.

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Treating diabetic retinopathy

• Laser surgery for macular edema
• Laser is focused on the damaged retina near the
  macula to decrease fluid leakage.
• Some may see laser spots near the center of their
  vision following treatment usually fade with
  time, but may not disappear.
• Uncommon for people who have blurred vision from
  macular edema to recover normal vision, although
  some may experience partial improvement.
• Main goal of treatment prevent further loss of
  vision.

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Treating diabetic retinopathy

• Laser surgery for PDR
• (Proliferative Diabetic Retinopathy)
• Laser is focused on all parts of the retina
  except the macula.
• This panretinal photocoagulation treatment
  causes abnormal new vessels to shrink often
  prevents them from growing again.
• Treatment decreases the chance that vitreous
  bleeding or retinal distortion will occur.
• Multiple laser treatments over time are sometimes
  necessary.

Laser panretinal photocoagulation treatment
(arrows show laser spots on the retina)
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Treating diabetic retinopathy

• Vitrectomy surgery for advanced PDR
• (Proliferative Diabetic Retinopathy)
• Occurs when the vitreous (white, gel-like
  substance in middle of eye) fills with blood.
• Performed in the operating room, this
  microsurgical procedure involves removing the
  blood-filled vitreous and replacing it with a
  clear solution.
• Often prevents further bleeding by removing
  abnormal vessels that caused bleeding.
• Multiple laser treatments over time are sometimes
  necessary.

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Diabetic retinopathy is controllable

• You can significantly lower your risk of vision
  loss by maintaining strict control of your blood
  sugar level.
• Treatment does not cure diabetic retinopathy but
  it is effective in preventing further vision
  loss.
• Most people with diabetes retain normal eyesight
  total blindness is very uncommon if retinopathy
  is treated.
• Regular visits to your ophthalmologist (Eye M.D.)
  will help prevent vision loss.